Review of severe osteoradionecrosis treated by surgery alone or surgery with postoperative hyperbaric oxygenation

We reviewed 41 patients with osteoradionecrosis of the mandible, Each patie nt was treated by radical resection followed by external beam irradiation. The diagnosis of infected osteoradionecrosis was confirmed clinically, radi ologically, and histologically, After operation had failed, 20/41 were give n hyperbaric oxygen (HBO) as in 'salvage' treatment. Daily sessions of HBO 2.5 ATA for 60 minutes (mean: 29 sessions) were given. The other 21 patient s were treated by operation and antibiotics alone. HBO group (n = 20): The overall success rate for HBO after operation had fa iled was 13/20. Repeated debridement as first-line treatment followed by po stoperative HBO was successful in 12/19, In seven of 19 patients, partial m andibulectomy and microvascular transplantation were required as second-lin e treatment, and this was successful in five. Primary partial mandibulectom y and microvascular transplantation followed by HBO was successful in 1 pat ient. Non-HBO group (n = 21): Repeated debridement was successful in 10/11 patien ts. Partial mandibulectomy was required as second-line treatment in the rem aining one. In the other 10, partial mandibulectomy and microvascular trans plantation were successful as first-line treatment in four. In the remainin g six, further surgical intervention became necessary and were successful f or 5-17 months (mean: 13). With a success rate of 13/20, we do not recommen d HBO for the treatment of osteoradionecrosis.